Methods of treating and diagnosing Parkinson&#39;s disease and related dysautonomic disorders

ABSTRACT

A method for treating a Parkinson&#39;s patient with digestive/pancreatic enzymes involves administering an effective amount of digestive/pancreatic enzymes to an individual having the disorder in order to improve a symptom of the disorder. In addition, a method is provided for determining whether an individual has, or may develop, Parkinson&#39;s disease or related dysautonomic disorders and for determining whether an individual will benefit from the administration of pancreatic/digestive enzymes to treat the dysautonomic disorder.

RELATED APPLICATIONS

This application is a divisional of U.S. application Ser No. 11/555,697, filed Nov. 2, 2006, which is a continuation-in-part of U.S. application No. 10/730,567, filed Dec. 8, 2003, now U.S. Pat. No.7,138,123, which is a continuation of U.S. application Ser. No. 09/929,592 filed Aug. 14, 2001, now U.S. Pat. No. 6,660,831, which claims the benefit of U.S. Provisional Application No. 60/224,991, filed Aug. 14, 2000. Each of these applications is herein incorporated in its entirety by reference.

FIELD OF THE INVENTION

The present invention generally relates to a method for treating Parkinson's disease and related dysautonomic disorders and a method for diagnosing individuals with Parkinson's disease or related dysautonomic disorders. More particularly, the invention relates to a diagnosis method of analyzing a stool sample of an individual for the presence of a biological marker (or marker compound) that provides an indication of whether the individual has, or can develop, Parkinson's disease or a related dysautonomic disorder, as well as a therapeutic method for treating Parkinson's disease or a related dysautonomic disorder by the administration of pancreatic/digestive enzymes.

BACKGROUND OF THE INVENTION

The nervous system of the body is comprised of two separate systems, the central nervous system and the peripheral nervous system. The peripheral nervous system is comprised of the somatic or “voluntary” nervous system and the autonomic or “automatic” nervous system.

The autonomic nervous system is further broken down into the parasympathetic, sympathetic, and enteric nervous systems. Additionally, it is known that the adrenal glands help to support the sympathetic responses of the autonomic nervous system and the enteric nervous system deals exclusively with the gastrointestinal system. With some overlap they each control various autonomic functions of the body through regulation so neurotransmitter releases which affect nervous control

Acetylcholine is a neurotransmitter used by the parasympathetic nervous system, while nor epinephrine is utilized by the sympathetic nervous system. The adrenal glands secrete epinephrine which help to support the sympathetic nervous system. Norepinephrine and epinephrine together with a substance most affected in Parkinson's disease; dopamine, make up a category of hormones known as the catecholamines.

The enteric nervous system exerts tremendous control over the digestive processes of the body, including gastrointestinal blood flow, secretion absorption, and overall breakdown of food. The enteric nervous system contains a significant number of neurons, thought to be as numerous as those found in the central nervous system. The enteric nervous system is comprised of three types of neurons: sensory, motor, and interneurons. While the sensory neurons are able to determine the environment of the lumen including chemical, ph, thermal and mechanical changes within the lumen, the motor neurons, including those to the pancreatic exocrine cells, control digestion and play a major role in the breakdown of food and the ultimate absorption of nutrients.

There are two network of nerve plexuses which constitute the enteric nervous system: the myenteric plexus and the submucous plexus. The two plexuses extend from the esophagus to the anus and thus run almost the entire route of the gastrointestinal system.

The submucous plexus, which is not continuous throughout the gastrointestinal tract, is located in the submucosal layer of the gastrointestinal tract. Its primary function is to assess the luminal activity of the GI system, and therefore exert tremendous control over GI blood flow, secretions into the lumen and absorption rates of such things as nutrients, water, and hormones such as secretin which is secreted into the blood stream as a result of the enteric nervous systems determination of low Ph of the bolus of food entering the small intestine. This further ultimately determines the role of the pancreatic/digestive enzymes.

The myenteric plexus controls digestive motility and is located in between the longitudinal and circular layers of muscle in the tunica muscularis. It is this segment of the enteric nervous system which may be initially affected in Parkinson's disease.

The overall digestive process includes the communication between the autonomic (enteric) nervous system and the central nervous system as digestion does not happen solely as a function of the autonomic nervous system. Additionally, there are significant enteric hormones that affect digestion, including secretin, which are under the control of the autonomic nervous system. From the autonomic nervous system, there is an overall increase in the stimulation of digestion from the parasympathetic branch of the autonomic nervous system which occurs mainly through the secretion of the neurotransmitter acetylcholine, while norepinephrine, secreted by the sympathetic nervous system decreases digestion in the gastrointestinal tract.

Dysautonomias are diseases and syndromes that relate to the autonomic nervous system of the individual. Hence in individuals afflicted with dysautonomias, many normal and automatic functions of the body are left with poor function or little to no function at all.

There are a plethora of dysautonomic disorders in which the symptoms of autonomic dysfunction are manifest. For instance, Parkinson's disease is marked by mild to severe autonomic dysfunction including changes in gait, tremor, discoordination, increased salivary flow, and overall loss of autonomic function. Additionally, changes in executive function are typically noted in a Parkinson's patient, often allowing the patient to appear as having Alzheimer's disease and resulting in misdiagnosis. Executive function disorders are also found in autistic children.

It has been noted that a lack of secretin response, which is directly under the control of the enteric nervous system, may underlie may other conditions. Further, the use of secretin directly as a therapeutic agent may be efficacious as in the case of those with familial dysautonomia.

Parkinson's disease is widespread throughout the Western hemisphere and was first reported by physician James Parkinson in 1817. Parkinson's disease is first detected as a tremor in a limb, and ultimately progresses to include 3 manifestations: (i) rigidity, which is characterized by “cog-wheel” like movement and “lead-pipe” rigidity; (ii) bradykinesia or slowness in movement, and (iii) postural instability associated with a stooped stance and an impaired gait. These altered movements are features of the motor dysfunction, but in addition there can also be a mental impairment in as many as 40% of all Parkinson's patients.

It is known that Parkinson's disease is caused by a deficient state of levo-dopamine in the brain. More specifically, levo-dopa induced dyskinesis in Parkinson's patients is thought to be a result of denervation of the substantia nigra. To date, medical science has not found a substrate that would allow an injectable form of levo-dopa to reach the brain and successfully cross the blood brain barrier. The current dopamine replacement therapy is aimed at either direct replacement or mimicking the action at the dopamine receptor sites in the brain. Sinemet™. and Sinemet CR™ are the two major drugs suited to that end. While the levo-dopa therapy can create some beneficial changes initially, those changes generally wane over time, and produce other problems such as severe sleep disturbance, dyskinesias, and constant nausea. Medical approaches to Parkinson's disease include surgical destruction of the tissue of the brain and the insertion of microelectrodes (deep brain electrical stimulation) to effected portions of the brain. The insertion of electrodes has the advantage of being reversible. These interventions, however, are generally transient and neither produces a permanent change in the Parkinsonian state nor reverses the effects of the disease.

Some authors suggest that Parkinson's disease is a multifactor, neurodegenerative disorder, which evolves due to excessive oxidation. The substantia nigra is susceptible to oxidative damage which supports this theory of the formation of Parkinson's disease. Abnormalities of the oxidative phosphorylation impair the mitochondria of the substantia nigra, and intensify free radical generation.

While the dyskinesias and loss of executive functioning of the brain receive the most significant mention with respect to Parkinson's disease, other physical manifestations exist that are associated with autonomic dysfunction which are often poorly understood. Some of these manifestations include, e.g.: esophageal reflux, diarrhea, and other gastrointestinal dysfunction. In addition, excessive sweating, sleep disturbances and other symptoms of Parkinson's disease are very similar to those found in familial dysautonomia.

It has long been held that protein restricted diets, timed protein intake diets, or low protein diets were essential for the absorption of certain medications, especially levo-dopa, in the patient afflicted with Parkinson's disease. Many studies have demonstrated the possibility that the large neutral amino acids (tryptophan, valine, isoleucine, leucine, tyrosine, phenylalanine) may interfere with the absorption of the 1-dopamine. Numerous studies have been performed and much postulation has been made about various diets. It has long been held by the inventor that there was a decrease in protein digestion in the dysautonomic patient, including those with Parkinson's disease. This lack of protein digestion would therefore necessitate an alteration in the protein intake in individuals with this type of dysfunction, including a decrease in the ingestion of certain proteins which may be difficult to digest without the presence of the necessary digestive enzyme and/or proper functioning of the secretin mechanism, and the over-ingestion of protein to make up for that which is not digested when there in an apparent impairment in protein digestive function. For example, if an individual needed 40 grams of protein a day to sustain function, but had only a mechanism which was 10% effective then the individual would gravitate toward a diet which was higher in protein and protein which would be easier to digest.

This fact has recently been demonstrated in a paper found in Movement Disorders: Protein Intake in Parkinsonian patients using the EPIC food frequency questionnaire by Marczewska on Apr. 18, 2006. In this paper, 45 Parkinson's patients were evaluated using the EPIC food questionnaire. While average caloric intake was normal in the Parkinson's patients, they consumed significantly higher amounts of protein (mainly in the form of vegetable proteins). The overall protein intake was 50% higher than the recommended daily allowance (1.2 g/kg vs. 0.8 g/kg). More importantly, it showed that the more severe the symptoms of the patient, the greater the protein intake by the patient.

Further, chymotrypsin appears to continue to be a biomarker for those with Parkinson's disease as the chymotrypsin cleaves only essential amino acids. If there is a dearth of chymotrypsin, then the essential amino acids needed by the body will not be available, and a greater ingestion of protein may be needed in order to attain sufficient essential amino acids.

Accordingly, in view of such findings, a method for determining whether an individual suffering from a dysautonomic disorder and/or any disorder comprising dysautonomic components will benefit from the administration of secretin, or pancreatic/digestive enzymes, would be highly advantageous. In addition, a method for aiding in the diagnosis of individuals who may develop Parkinson's disease and related conditions or symptoms is highly desirable.

SUMMARY OF THE INVENTION

The present invention is directed to methods for aiding in the diagnosis of Parkinson's disease and related disorders, and for treating individuals diagnosed as having Parkinson's disease or related disorders.

In one embodiment, a method is provided for treating Parkinson's disease patients, including those who are likely to develop the disorder or those who presently have the disorder, through the administration of digestive/pancreatic enzymes.

In another embodiment, a diagnostic method is provided for determining whether an individual has, or may develop, Parkinson's disease or related disorders and for determining whether an individual will benefit from the administration of pancreatic/digestive enzymes to treat the dysautonomic disorder. In one embodiment, the diagnostic method analyzes a compound in a stool sample of an individual and correlates the analysis of the compound with a dysautonomic disorder or condition or the lack thereof. In one embodiment, the compound to be analyzed is a pancreatic enzyme, such as chymotrypsin, or any compound that provides an indication of either protein digestion or metabolism, pancreatic function, or an inflammatory process, or a combination thereof. In one embodiment, the analysis determines a quantitative level of the compound in the stool.

In a further embodiment, a method for treating a Parkinson's patient with digestive/pancreatic enzymes involves administering an effective amount of digestive/pancreatic enzymes to an individual having the disorder in order to improve a symptom of the disorder.

In yet another embodiment, a method for treating a Parkinson's patient with digestive enzymes/pancreatic enzymes involves analyzing a compound in a stool sample of the individual in which the administration of the digestive enzymes/pancreatic enzymes is based on the analysis of the stool sample. In one embodiment, the compound to be analyzed comprises a pancreatic enzyme, such as chymotrypsin, or any compound that provides an indication of either protein digestion or metabolism, pancreatic function, or an inflammatory process, or a combination thereof.

In yet a further embodiment, a process for analyzing the stool sample involves measuring a quantitative level of a pancreatic enzyme, such as chymotrypsin, present in the stool sample and comparing the measured quantitative level with at least one threshold level to determine the efficacy of the digestive enzyme/pancreatic enzyme administration to the individual. In one embodiment, the threshold level is based on a level of the pancreatic enzyme associated with at least one other individual of the same approximate age that does not have Parkinson's disease.

In an additional embodiment, a formulation of digestive enzymes/pancreatic enzymes is provided which is efficacious for the treatment of Parkinson's disease and related disorders.

The features and advantages described herein are not all-inclusive and, in particular, many additional features and advantages will be apparent to one of ordinary skill in the art in view of the drawings, specification, and claims. Moreover, it should be noted that the language used in the specification has been principally selected for readability and instructional purposes, and not to limit the scope of the inventive subject matter.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graph demonstrating the decrease in occurrences of constipation in Parkinson's patients after administration of digestive enzymes over a period of 180 days.

FIG. 2 is a graph demonstrating the increase in the number of bowel movements in Parkinson's patients after administration of digestive enzymes over a period of 180 days.

FIG. 3 is a graph demonstrating the decrease in occurrences of tremors in Parkinson's patients after administration of digestive enzymes over a period of 180 days.

FIG. 4 is a graph demonstrating the decrease in occurrences of falls in Parkinson's patients after administration of digestive enzymes over a period of 180 days.

FIG. 5 is a graph demonstrating the changes in ambulation in Parkinson's patients after administration of digestive enzymes over a period of 180 days.

FIG. 6 is a graph demonstrating the difference in the fecal chymotrypsin levels of Parkinson's and non-Parkinson's subjects.

DETAILED DESCRIPTION

The present invention is directed to methods for aiding in the diagnosis of dysautonomic disorders and dysautonomic conditions, and for treating individuals diagnosed as having a dysautonomic disorder and other disorders having dysautonomic components. In one embodiment, a method is provided for determining the presence of abnormal protein digestion and/or pancreatic dysfunction of an individual, especially a child, by analyzing a stool sample of the individual for the quantitative levels of one or more pancreatic enzymes including, but not limited to, chymotrypsin, so as to determine if the individual has, or may develop, a dysautonomic disorder or condition. In another embodiment, a method is provided for determining whether the individual is likely to benefit from the administration of secretin, CCK, VIP, digestive enzymes, other peptides, and/or neuropeptides. Until now, there has been no clear biological marker for dysautonomic disorders or conditions to allow early diagnosis or screening of such disorders or conditions.

It has been discovered by the inventor herein that a population of individuals suffering from dysautonomic disorders such as Parkinson's disease have abnormal or pathologic levels of pancreatic enzymes such as chymotrypsin in their stools. It is postulated that in dysautonomic syndromes, the partial paresis of the gastrointestinal tract, and therefore the lack of functioning of the secretory cells of the proximal small intestine, preclude the proper formation and/or release of secretin. It is further postulated that this abnormal protein digestion, as reflected by the low levels of pancreatic enzymes such as chymotrypsin, can be improved by the administration of secretin, CCK, VIP, other neuropeptides, peptides, and/or digestive enzymes to thereby ameliorate the symptoms of dysautonomic conditions. Indeed, as a low measure of fecal chymotrypsin, for example, expresses an abnormality of protein digestion and/or pancreatic dysfunction, it is postulated that an improvement of protein digestion to promote normal growth and development of an individual suffering from a dysautonomic disorder or dysautonomic condition by the administration of secretin, CCK, VIP, other neuropeptides and/or peptides and/or digestive enzymes, can ameliorate the dysautonomic symptoms.

In one embodiment, a stable preparation of digestive/pancreatic enzymes is formed into a dosage formulation containing a therapeutically effective amount of a protease, an amylase, and/or a lipase. The formulation may include additional enzymes, such as pancreatin, chymotrypsin, trypsin, papain and/or papaya. The dosage formulation may be administered by an oral preparation including, but not limited to, an encapsulated tablet, mini-tabs, microcapsule, mini-capsule, time released capsule, sprinkle or other methodology. In one embodiment, the oral preparation is encapsulated using PROSOLV® technology. Alternatively, the oral preparation may be encapsulated using enteric coating, lipid encapsulation, direct compression, dry granulation, wet granulation, and/or a combination of these methods.

The dosage formulations may be as follows (USP=U.S. Pharmacopeia):

EXAMPLE 1

Amylase 10,000-70,000 USP units/dose Protease 10,000-80,000 USP units/dose Lipase 4,000-40,000 USP units/dose Pancreatin 2,000-6,000 USP units/dose Chymotrypsin 2-5 mg Trypsin 60-100 mg Papain 3,000-30,000 USP units/dose Papaya 30-500 mg

EXAMPLE 2

Protease 40,000 USP units/dose Chymotrypsin 2-7 mg Trypsin 60-100 mg Papaya 30-500 mg

EXAMPLE 3

Amylase 30,000 USP units/mg Protease 40,000 USP units/mg Lipase 30,000 USP units/mg Chymotrypsin 2-7 mg Papaya 30-500 mg

EXAMPLE 4

Amylase 30,000 USP units/dose Protease 40,000-80,000 USP units/dose Lipase 30,000-80,000 USP units/dose Chymotrypsin 2 mg Papain 6,000-30,000 USP units/dose

Other combinations of digestive enzymes may also be used. These enzymes can be in the form of animal or plant derivatives, natural or synthetic.

In a study conducted by the inventor, sixteen subjects diagnosed with Parkinson's disease and ranging in age from 41 to 71 were examined were examined. Physical symptoms of the disease, such as constipation, lack of bowel movements, tremors, falling, and an inability to walk were monitored and measured over a period of 180 days. The subjects were given a dosage of digestive enzymes 3-5 per day. The dosages were administered in the form of encapsulated tablets, capsules, and sprinkles. The dosages were taken with meals and snacks. The digestive enzyme dosage included, but was not limited to, one or more of the following: amylases, proteases, pancreatin, papain, papaya, lipases, chymotrypsin, and trypsin.

Ninety-five percent of adults have bowel movements between three and 21 times per week, and this would be considered normal. The most common pattern is one bowel movement a day. However, some people do not have bowel movements every day or the same number of bowel movements each day. Medically speaking, constipation usually is defined as fewer than three bowel movements per week. Severe constipation is defined as less than one bowel movement per week.

Referring to FIG. 1, a majority of the subjects experienced moderate to severe constipation prior to any treatment with digestive enzymes. The severity of the constipation was measured on a scale of 1 to 7, with 1 equaling no constipation and 7 equaling severe constipation. The subjects were monitored at 30, 90, 120 and 180 day intervals. Over the course of the 180 day treatment, the severity of the constipation decreased from severe to moderate to mild in the majority of the subjects.

Referring to FIG. 2, the number of bowel movements per week experienced by most of the subjects was lower than normal prior to any treatment with digestive enzymes. The subjects were monitored at 30, 90, 120 and 180 day intervals. Over the course of the 180 day treatment, the number of bowel movements per week increased to 3 or more in the majority of subjects.

Static tremors, or “resting tremors”, are tremors that occurs despite the limb being fully supported and at rest against gravity. They usually progress at the rate of 4-7 Hz (hertz), and are the typical Parkinsonian tremor. The amplitude of the tremor often decrease with sleep, complete relaxation or voluntary activity. Tremors are often the first symptom that people with Parkinson's disease or their family members notice. Initially, the tremors may appear in just one limb (arm or leg) or only on one side of the body. The tremors also may affect the lips, tongue, neck, or eyelids. As the disease progresses, the tremors may spread to both sides of the body, although in some cases the tremors remain on just one side. Emotional and physical stress tend to make the tremors worse.

Referring to FIG. 3, a majority of the subjects experienced severe tremors prior to any treatment with digestive enzymes. The severity of the tremors was measured on a scale of 1 to 7, with 1 equaling no tremors and 7 equaling severe tremors. The subjects were monitored at 30, 90, 120 and 180 day intervals. Over the course of the 180 day treatment, the severity of the tremors decreased from severe to moderate to mild in a majority of the subjects.

Many Parkinson's patients develop gait and balance problems and this can lead to falls. Ambulation is with a stooped posture using a short, shuffling gait. This is primarily due to the loss of balance control. Unfortunately with Parkinson's disease, the muscles become stiff and patients have difficulty swinging their arms when walking which helps in keeping one's balance. They also have episodes of freezing which literally have them “stuck in place” when initiating a step and they exhibit a slight foot drag which makes tripping easy. Persons with Parkinson's have difficulty in judging spatial relationships. Thus, falls often happen when navigating through doorways or through narrow passages.

Referring to FIG. 4, a majority of the subjects experienced an elevated number of falls prior to any treatment with digestive enzymes. The subjects were monitored at 30, 90, 120 and 180 days. Over the course of the 180 day treatment, the number of falls decreased to less than two per week in a majority of the subjects.

Referring to FIG. 5, a majority of the subjects experienced severe difficulty in ambulation prior to any treatment with digestive enzymes. The difficulty in ambulation was measured on a scale of 1 to 7, with 1 equaling no difficulty and 7 equaling severe difficulty. The subjects were monitored at 30, 90, 120 and 180 day intervals. Over the course of the 180 day treatment, the difficulty in ambulation decreased from severe to moderate to some or no difficulty in a majority of the subjects.

Fecal chymotrypsin levels were also measured in the 16 subjects and compared to the fecal chymotrypsin levels of 16 subjects who did not have Parkinson's disease. The non-Parkinson's subjects ranged in age from 44 to 77. Fecal chymotrypsin is a sensitive, specific measure of proteolytic activity. Normal levels of chymotrypsin are considered be greater than 8.4 U/gram. Decreased values (less than 4.2 U/gram) suggest diminished pancreatic output (pancreatic insufficiency), hypoacidity of the stomach or cystic fibrosis. Elevated chymotrypsin values suggest rapid transit time, or less likely, a large output of chymotrypsin from the pancreas.

A stool sample was collected from each of the subjects. Each stool sample was analyzed using an enzymatic photospectrometry analysis to determine the level of fecal chymotrypsin in the stool. Alternatively, other methods, such as the colorimetric method, use of substrates, use of assays, and/or any other suitable method may be used to measure the fecal chymotrypsin levels. The levels of fecal chymotrypsin in the Parkinson's patients was compared to the levels of fecal chymotrypsin in the non-Parkinson's subjects to determine if the Parkinson's patients would benefit from the administration of digestive enzymes.

Referring to FIG. 6, the fecal chymotrypsin levels of the Parkinson's patients ranged from 0.8 to 6.6 U/gram, with a mean of 2.84 U/gram, while the fecal chymotrypsin levels of the non-Parkinson's patients ranged from 9.2. to 47.4 U/gram, with a mean of 28 U/gram. Thus, it can be seen that the fecal chymotrypsin levels of the Parkinson's patients were markedly decreased when compared to the non-Parkinson's subjects.

In summary, the results of the study described herein demonstrate that administration of digestive enzymes benefits individuals having a dysautonomic disorder, such as Parkinson's disease, by ameliorating the symptoms of the disorder. Furthermore, the results of the study indicate that measurement of the fecal chymotrypsin level in individuals having a dysautonomic disorder can determine if the individual will benefit from the administration of digestive enzymes.

The foregoing description of the embodiments of the invention has been presented for the purposes of illustration and description. It is not intended to be exhaustive or to limit the invention to the precise form disclosed. Many modifications and variations are possible in light of this disclosure. It is intended that the scope of the invention be limited not by this detailed description, but rather by the claims appended hereto. 

The invention claimed is:
 1. A method of treating an individual having Parkinson's disease with a therapeutically effective amount of a pharmaceutical composition comprising a protease, a lipase, and an amylase, comprising: measuring a level of fecal chymotrypsin in a stool sample of the individual; comparing the level of fecal chymotrypsin with a normal fecal chymotrypsin level; and administering the pharmaceutical composition comprising a protease, a lipase, and an amylase to the individual if the level of fecal chymotrypsin in the individual is less than the normal fecal chymotrypsin level.
 2. The method of claim 1, wherein the pharmaceutical composition is administered to the individual in an amount effective to promote protein digestion in the individual.
 3. The method of claim 1, wherein the normal fecal chymotrypsin level is approximately 8.4 U/gram.
 4. A method of treating an individual having Parkinson's disease comprising: administering a pharmaceutical composition comprising a protease, a lipase, and an amylase to the individual if the level of fecal chymotrypsin in the individual is less than a normal fecal chymotrypsin level, wherein the level of fecal chymotrypsin is measured in a stool sample of the individual.
 5. The method of claim 4, wherein the normal fecal chymotrypsin level is approximately 8.4 U/gram.
 6. The method of claim 1 or 4, wherein the pharmaceutical composition is an oral dosage form suitable for human use.
 7. The method of claim 1 or 4, wherein one or more symptoms of Parkinson's disease is ameliorated in the individual.
 8. The method of claim 4, wherein the individual having Parkinson's disease has one or more symptoms selected from the group consisting of: constipation, bowel movement frequency, tremors, falls, and difficulty in ambulation, and a combination thereof. 